Which Factors Predict the Mental Health Benefits of Psychedelics?

There is an increase in awareness that many psychedelic compounds, when combined with psychotherapy, are effective at alleviating a range of mental health problems [1]. However, researchers still want to know which factors are relevant when it comes to alleviating (often severe and chronic) forms of emotional distress. Already some insights have been gained, with certain kinds of subjective experiences being related to the long-term psychological well-being of patients. Now a recent study, published in the Journal of Affective Disorders, is adding to this picture [2]. 

It’s crucial to better understand the factors that predict either a positive or negative response to psychedelics, so that the mental health benefits of psychedelic therapy can be maximized and potential harms mitigated, respectively.

Subtypes of the Psychedelic Experience Have Predictable Effects on Mental Health 

This recent study – the first author of which is Aki Nikolaidis at the Child Mind Institute, with co-authors including prolific psychedelic researchers Alan K. Davis and Roland Griffiths from Johns Hopkins University – characterizes certain aspects of the psychedelic experience and links them to mental health outcomes.

The researchers analyzed data from a survey of 985 participants about their past (non-clinical) use of psychedelics. The compounds included in the survey were psilocybin, LSD, ayahuasca, N,N-DMT, 5-MeO-DMT, mescaline, salvia/salvinorin A, peyote cactus, and iboga/ibogaine. The category “other” was used too, in case survey respondents had experiences with other psychedelics.

The participants completed four questionnaires about their previous psychedelic experiences, each of which focused on a particular subjective effect. The questionnaires used were the Mystical Experiences Questionnaire (MEQ), Psychological Insight Questionnaire (PIQ), the Challenging Experiences Questionnaire (CEQ), and a Salient Emotions questionnaire. They then looked at the relationship between scores on these different questionnaires and scores on measures relating to long-term changes; depression, anxiety, and stress; satisfaction with life; and psychological flexibility (the ability to adapt to different or difficult experiences). 

The researchers discovered that participants who scored highest on the MEQ and PIQ measures and low on the CEQ measure experienced the most benefit in terms of anxiety and depression symptoms being in remission and other enduring benefits. This same pattern emerged when researchers analyzed only data from participants who had used psilocybin and LSD. This suggests that there are subtypes of psychedelic subjective effects – or distinct kinds of experiences you can have while in an altered state – that reliably predict mental health outcomes regardless of which psychedelic a person uses. Mystical effects, for example, which are measured using the MEQ, are a subtype that includes unique experiences like unity, ineffability, deeply felt positive mood, and transcendence of space and time.

Nonetheless, this doesn’t mean that a challenging psychedelic experience can’t be beneficial. The analysis revealed that an experience that feels frightening or destabilizing can have beneficial outcomes, particularly if it occurs in the context of a mystical and insightful experience. Indeed, as Dr. Davis stresses, “an intensely mystical and insightful experience that can, in and of itself, be challenging.” And this is not surprising, as mystical experiences can include effects like ego dissolution and losing one’s sense of time and space, which can feel disorientating, scary, and overwhelming, especially when such effects are resisted. Psychological insight – or insights into particular memories, emotions, relationships, behaviors, and beliefs – may also be challenging.

This finding echoes previous research from Griffiths and others, which found that most participants – despite difficulties arising from a challenging psychedelic experience (or their worst ‘bad trip’) after taking psilocybin mushrooms – endorsed benefiting from the experience [3]. The authors add: “The incidence of risky behavior or enduring psychological distress is extremely low when psilocybin is given in laboratory studies to screened, prepared, and supported participants.” 

Other research, published in the International Journal of Drug Policy, describes how unpleasant experiences during bad trips (characterized by the feeling of going crazy or losing one’s sense of self) can lead to beneficial outcomes, sometimes giving people deep existential and life-altering insights. The construction of particular narratives around bad trips was also tied to the ability to transform them into valuable experiences [4].

The researchers additionally discovered that participants who had highly mystical and insightful experiences and not very challenging experiences were more likely to be younger. Moreover, a higher proportion of participants who had taken larger doses of psychedelics scored the highest on the CEQ measure. This latter finding makes sense, of course, as taking high doses of psychedelics increases the chances of strong emotions (including negative ones), overwhelm, and confusion. Also, taking high doses in a non-clinical context – where adequate preparation, professional psychological support, and an optimal setting are often lacking – means that emotional distress can be harder to manage.

Dr. Davis notes that this study opens up interesting avenues for other research. He said, “Finding the variety of other outcomes that these subtypes might be related to is an interesting next step. These could include adaptive or functional outcomes in people’s quality of life or well-being, or a better understanding of their life’s purpose or relationships.”

Study Limitations

There are, nevertheless, some limitations of the study. For example, as the authors state, “Data were obtained via retrospective self-report, which does not allow for definitive conclusions about the direction of causation between baseline characteristics of respondents, qualities of subjective experience, and outcomes.” The authors also concede that the design of the study is prone to recall bias since it employed “then-test” items to assess symptoms before and after the psychedelic experience. “Participants may have reported their baseline symptoms as worse than they actually were because of their improved present state,” as the authors point out. 

Also, there may be aspects of the psychedelic experience that were not captured by the study, which may be relevant in terms of beneficial outcomes. The survey specifically recruited people who had a previous psychedelic experience that resulted in psychological insight. This recruitment strategy, therefore, did not cover the breadth of subtypes of the psychedelic experience. 

Other research has revealed, for example, that emotional breakthroughs – measured by the Emotional Breakthrough Inventory (EBI), which includes the experience of facing difficult emotions, gaining closure on an emotional problem, resolving a personal conflict/trauma, and emotional release – are linked to increases in mental well-being [5]. However, the PIQ measure does cover such experiences to an extent. As researchers from Imperial College London note in a 2022 paper published in the Journal of Psychopharmacology, “A major focus of the EBI is an individual’s ability to face emotionally difficult feelings or past experiences and, in so doing, experience emotional breakthrough, which overlaps somewhat with our operational definition of insight” [6].

An Emerging Pattern

The research already discussed indicates that mystical, insightful, and emotionally meaningful experiences while under the influence of psychedelics mediate mental health outcomes. Other research has explored the link between subjective psychedelic effects and mental health outcomes, again finding that mystical experiences, psychological insight, and connection with one’s emotions are associated with lasting symptom reduction and improvements in life satisfaction, attitudes, outlook, and behavior [7,8]. 

The emerging pattern from a wealth of research is that the quality of the psychedelic experience matters when it comes to whether patients experience significant and lasting reductions in mental distress and increases in quality of life. And there are other related factors that influence such outcomes. For example, psychedelic researcher Sam Gandy highlights that [9]:

“Set and setting, drug dosage, trait absorption [the predisposition to be deeply absorbed in mental imagery, sensory stimuli, or mystical experiences], drug type, intention, and states of surrender and acceptance all predict or influence the occurrence of mystical experiences. Various additional factors may further contribute to the occurrence and intensity of mystical experiences and enhance their long-term benefits, including music, meditation and spiritual practices, and nature-based settings.”

By taking these factors into account, psychedelic therapists will be able to increase the likelihood that a client will have a psychedelic-induced mystical experience and experience long-lasting improvements to mental health. But it’s important to consider the broad range of subjective effects that can also benefit people and understand the factors that maximize or minimize them. This broader understanding of how psychedelics work will help to improve both the efficacy and safety of psychedelic-assisted therapy. 

References

1. Cavarra M., Falzone A., Ramaekers J.G., Kuypers K.P.C., & Mento C. (2022). Psychedelic-Assisted Psychotherapy – A Systematic Review of Associated Psychological Interventions. Frontiers in Psychology, 13, Article: 887255.
2. Nikolaidis A., Lancelotta R., Gukasyan N., Griffiths R.R., Barrett F.S., & Davis A.K. (2023). Subtypes of the psychedelic experience have reproducible and predictable effects on depression and anxiety symptoms. Journal of Affective Disorders, 1(324), 239-249.
3. Carbonaro T., Bradstreet M.P., Barrett F.S., MacLean K.A., Jesse R., Johnson M.W., & Griffiths R.R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology, 30(12), 1268-1278.
4. Gashi L., Sandberg S., & Pedersen W. (2021). Making “bad trips” good: How users of psychedelics narratively transform challenging trips into valuable experiences. International Journal of Drug Policy, 87, Article: 102997.
5. Roseman L., Haijen E., Idialu-Ikato K., Kaelen M., Watts R., & Carhart-Harris R. (2019). Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory. Journal of Psychopharmacology, 33(9), 1076-1087.
6. Peill J.M., Trinci K.E., Kettner H., Mertens L.J., Roseman L., Timmermann C., Rosas F.E., Lyons T., & Carhart-Harris R.L. (2022). Journal of Psychopharmacology, 36(1), 31-45.
7. Ko K., Knight G., Rucker J.J., & Cleare A.J. (2022). Psychedelics, Mystical Experience, and Therapeutic Efficacy: A Systematic Review. Frontiers in Psychiatry, 12, Article: 917199.
8. Roseman L., Demetriou L., Wall M.B., Nutt D.J., & Carhart-Harris R.L. (2018). Increased amygdala responses to emotional faces after psilocybin for treatment-resistant depression. Neuropharmacology, 142, 263-269.
9. Gandy S. (2022). Predictors and potentiators of psychedelic-occasioned mystical experiences, 6(1), 31-47.